be studied in several research contexts. One set of relevant outcomes relates to the immediate consequences of mistreatment itself, including such factors as return to previous health status, wound or fracture healing rates, preservation or loss of psychological well-being, the status of general chronic disease control measures, and the immediate social and legal responses to mistreatment. Another set of outcomes relates to the effects of whatever interventions transpire, not only on the rates and intensity of further mistreatment, but also on new and preexisting medical conditions, victim satisfaction with the intervention, the types of medical service utilization engendered, the costs of the intervention process, and the long-term costs of social and medical care.

One particularly interesting question is whether, and under what circumstances, subjective measures of personal security or well-being could be developed as an ultimate outcome measure, both for the effects of mistreatment as well as for the effects of interventions. Obviously, many other factors affect an individual’s personal sense of security, and studies using such a measure of outcome would have to deal with this problem methodologically, but this is a challenge worth undertaking. As a research question, it would be interesting to know whether this perception is related to the ability to restore optimal medical and mental health and well-being after elder mistreatment is detected and addressed.

Interface with the Public Health, Medical Care, and Social Services Systems

From a community perspective, it is clear that cases of elder mistreatment are underascertained by existing public health, social, medical, and legal activities and systems; this is understandable despite the need for improvement. Several papers in this volume acknowledge the important roles of these systems and programs in identifying cases as one technique for determining elder mistreatment occurrence. This is particularly true since a substantial proportion of elder mistreatment episodes appear to occur in frail elders, who are perhaps least likely to participate in household surveys. As reviewed by Acierno and Dyer et al. (this volume), there has been considerable work in trying to improve recognition of elder mistreatment in the formal program setting, especially within clinical health and social services. It seems clear that more research is needed on the interface of elder mistreatment with these services, and it is important to understand the nature and value of increased and more refined medical and social surveillance and screening practices on geographically based elder mistreatment rates. Health care settings could be particularly important, since each year approximately 85 percent of persons age 65 and older use formal ambulatory care services and 16–20 percent are hospitalized. With the

The National Academies of Sciences, Engineering, and Medicine 500 Fifth St. N.W. | Washington, D.C. 20001